Disease vectors

Yesterday, we were told that two-thirds of all cancer deaths in America are avoidable. Our unhealthy lifestyles, smoking and unhealthy diets, are to blame.

The President’s Cancer Panel has focused on the obesity epidemic, saying that obesity -- "the product of unhealthy diet and physical inactivity" -- is linked to higher risks for numerous cancers. It pointed to “disease vectors” in our country that must be “unmasked and resisted” because they “are at the core of so much of the cancer and other chronic diseases that are sickening and killing Americans by the hundreds of thousands each year.”

This may be one of the most egregious departures from the scientific evidence taken by a governmental group in the war on obesity to date. Fat people, like smokers, are to become social outcasts. Tragically, those with health problems, such as cancer, are being blamed for their illnesses and made to feel they’re at fault. And everyone else, including children, is being frightened with threats of cancer and early death if they don’t behave. And nowhere is there any evidence that this will help people.

In its just-released annual report titled, “Promoting Healthy Lifestyles,” the PCP called for a change in cultural norms so that obesity, unhealthy diets and behaviors, and tobacco use are “viewed as unacceptable:”

Public attitudes must be modified through policy, persuasion, and access such that it becomes the norm to be personally committed to a healthy lifestyle.

Public officials and governmental institutions, it said, “have a moral obligation to protect the public health [and] must assert their collective political will to change policies contributing to the obesity epidemic and continued tobacco use, both of which result in increased cancer risk and incidence.” And individuals must “assume personal responsibility” to make healthy lifestyle choices.

It’s hard to ignore that the Panel’s initiatives appear more politically motivated than based on good science. Equally apparent are the similarities to the agenda of the Robert Wood Johnson Foundation. Dwayne Proctor, Ph.D., M.A. of the RWJF was quoted in the report as saying: “We all must come to grips with the reality that our society has dramatically altered the way we live, eat, work, and play.” The National Cancer Institute has had a long relationship with RWJF, which for years has funded the NCI’s anti-tobacco efforts with millions of dollars. So, it’s not surprising that RWJF, which has recently committed $500 million to address childhood obesity, participated in the development of this latest report and is cited throughout it.

Among the recommendations to “halt and reverse current obesity trends,” the PCP called for a collaboration of government and private organizations, industry, educators and individuals to:

· restrict the availability of unhealthy, bad food (such as processed foods and high fructose corn syrup) especially in schools

· regulate food advertising to children

· greater public education to “teach children and adults about healthy eating to avoid cancer, heart disease, hypertension, and diabetes”

· motivate the health insurance industry to cover cancer prevention services, nutritional counseling and obesity-related treatments

· community design to incentivize physical activity

· get employers to motivate employees to control their weight and make healthier choices in wellness programs

· and that “the Farm Bill provides an opportunity that must not be missed”

As Dr. Sydney Smith at Medpundit noted, the panel wasn’t concerned with just any disease vectors, just those “with marketing savvy.” She wrote:

Put aside the gross misuse of the term vector and consider the thrust of the argument - that preventing cancer is a matter of lifestyle choices. If only!

Tobacco use is a lifestyle choice that increases the risk of cancer, to be sure. But it's pretty hard to make an argument these days that government encourages the use of tobacco. Between the taxes and the bans, government has come down hard on the industry. And smokers themselves have become social pariahs. What about other cancers? Cervical cancer has a lifestyle component, but somehow I doubt the Cancer Panel meant to imply that schools (or the government) should teach sexual continence. Skin cancer has a lifestyle component, but there's no mention in the statement about limiting access to tanning beds.

Other cancers - colon cancer, breast cancer, prostate cancer, ovarian cancer, etc., etc., etc. - have little to no lifestyle component to them. It's true that there are no shortage of media reports that bad diets cause cancer and good diets prevent cancer, but the truth is unless you are eating radioactive food, the link between diet and cancer is tenuous at best. As they say in medicine, the link needs more research. Ditto with cancer and exercise.

One would hope that the people who are expert enough to sit on a Presidential Cancer Panel would have more sense than this panel has demonstrated. But then, exercising sense rarely gets the attention that hyperbole gets, does it?

The NCI panel is not only ignoring the body of clinical evidence — which has continued to show that “healthy” diets and lifestyles do not prevent cancer or its recurrence — it's disregarding its own reports. We’ve examined many of these studies here, such as the Women’s Healthy Eating Living (WHEL) trial, one of the largest and most comprehensive diet prevention studies ever conducted, which found that healthy eating (low-fat foods and lots of fruits and vegetables) had no affect on breast cancer outcomes. And the comprehensive review of scientific studies done for the NCI found that claims surrounding healthy eating were built on a series of correlations found in case-control studies, but not supported by clinical trials. For example, “data from 8 prospective trials found no association between intake of fruits and vegetables and reduced risk of breast cancer.”

The two year review by the U.S. Food and Drug Administration (FDA) Center for Food Safety and Applied Nutrition on the scientific evidence on antioxidants in the diet, such as lycopene, recently found no evidence the antioxidant reduced any cancers evaluated. And then, there’s the NCI’s latest report, “Annual Report to the Nation on the Status of Cancer, 1975-2003.” It stated that the incidences of colon and rectal cancers (even despite increased surveillance) have been dropping among both men and women. While average weights have increased. Cancer registries in the United States have continued to find that “obesity is associated with lower incidence rates of colorectal cancer,” as researchers at the Kansas Cancer Registry reported in the journal Cancer this past fall.

The NCI’s 2006 Fact Book even contradicts this Panel’s claims. It showed that incidences of most all cancers have dropped over the past decade, notably those claimed to be associated with obesity and smoking. The cancer showing the main increase in incidence and mortality is liver cancer, largely attributed to hepatitis viral infections, as discussed here. Yet, as Dr. Smith noted with other preventive measures that might actually have efficacy, the PCP panel report also didn’t even mention hepatitis and HIV prevention.

When agendas trump the most careful scientific evidence and what may most help people, one has to wonder if consumers might be better off making their own health decisions rather than follow those from vested interests. The NCI’s budget (see figure) has skyrocketed over recent decades and now totals over $4.747 billion. Perhaps, they're looking harder to justify these exorbitant expenditures.

Exercising good sense rarely gets the funding that hyperbole does, too.

© 2007 Sandy Szwarc